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A large volume of clinical research articles exist. The articles are similar and different in terms of their content, objectives, timelines, authors, methodologies, findings among other aspects. The variations make it hard to retrieve relevant articles that provide answers to the topic at hand. To determine the usefulness of an article, there is a need to critically appraise the suggested articles. The appraisal assists in the critical and systematic examination of research papers to determine their value, relevance, and integrity (Morrison, 2017).  Critical appraisal guides one in examining factors like internal validity and methods of study among others. The purpose of this paper is to critically appraise two qualitative and quantitative research articles by outlining their background, relevance, method of study, results, ethical considerations, and outcome comparisons.

Background

The selected quantitative articles were assessing the impact of mindfulness on nurse burnout. Gholizadeh et al. (2017) outlined that the nursing profession is stressful and requires the use of mindfulness practice to reduce pain systems and increase openness, agreement, and conscientiousness. The authors pointed out that although mindfulness results in decreased job stress, there is limited research examining the effects of a mindfulness intervention on job stress levels among nurses working in ICU. Penque (2019) also agrees that working in critical care and ED is stressful and results in burnout and increased intentions to leave the job. The negative impact should be mitigated by introducing a program like mindfulness-based stress reduction (MBSR) that teaches nurses to accept their lived experiences. MBSR decreases stress and burnout and enhances self-compassion. To find the effectiveness of MBSR, Penque (2019) executed a study that assessed job burnout, incidental overtime, work satisfaction, empathy, self-compassion, and mindfulness.

From the qualitative articles, Hugh-Jones, Rose, Koutsopoulou, and Simms-Ellis (2018) executed a study examining

how mindfulness intervention reduces stress in the workplace. Hugh-Jones et al. (2018) pointed out that persistent psychological stress is associated with an inflammatory response that causes most of the chronic physical conditions.  The response increases the risk of coronary heart disease, major depressive disorder, smoking, overeating, and alcohol misuse among others. To reduce these risks, mindfulness-based approaches have been adopted in various workplaces. The authors aimed at establishing how workplace mindfulness-based interventions increase positive benefits. Lynch et al. (2018) indicated that rates of burnout and stress among healthcare practitioners are increasing. An affected area is the emergency department with a majority of staff reporting compassion fatigue, cynicism, depression, and suicide. The negative effects can be reduced using meditative practice like the mantra meditation (MM). MM results in improved self-reported spiritual well-being, stress, anger, anxiety, mindfulness traits and quality of life. Lynch et al. (2018) set out to obtain in-depth qualitative feedback on the ED staff’s experience of an MM program.

Articles Support the Nursing Issue

The PICOT question followed is “In nurses working at the intensive care unit, will the use of mindfulness-based practices compared to breaks reduce incidences of burnout among them?” The nursing issue under research is the reduction of nurse burnout among ICU nurses using mindfulness-based practice. The four articles support the issue because they are assessing the impact of mindfulness on stress and burnout. For instance, Gholizadeh et al. (2017) look at how mindfulness reduces stress among ICU nurses. Stress is a major cause of nurse burnout. Penque (2019) on the other hand looks at how MBSR affects job-relevant factors like job burnout. Hugh-Jones et al. (2018) explain how mindfulness reduces stress in the workplace while Lynch et al. (2018) addresses the impact of mantra meditation on rates of burn out and stress among healthcare professionals working in the emergency department. In terms of the participants both Gholizadeh et al. (2017) and Penque (2019) have intervention groups receiving either mindfulness or MBSR respectively and control groups with no intervention. The proposed study has an intervention group receiving mindfulness-based practice and a control group receiving only breaks.

Methods of Study

For the quantitative articles, the methods used were randomized control trials and quasi-experimental design. Gholizadeh et al. (2017) adopted a randomized control study design that helps in the random assignment of participants into intervention and control groups whereas Penque (2019) used the quasi-experimental design which uses non-randomized intervention studies  (LoBiondo-Wood & Haber, 2017).   Gholizadeh et al. (2017) used RCT because it is a gold standard when determining causality and offers high-quality evidence that informs nursing practice. However, RCTs require clinical equipoise where the selected treatments have equal support in the clinical community (LoBiondo-Wood & Haber, 2017).  Penque (2019) used quasi-experiments because it eliminates the directionality problem. After all, one manipulates the independent variable before measuring the dependent variable (LoBiondo-Wood & Haber, 2017). A disadvantage of quasi-experiment is that it does not eliminate the problem of confounding variables since participants are not randomly assigned.

The qualitative articles employed semi-structured interviews (Lynch et al., 2018; Hugh-Jones et al., 2018). A semi-structured interview provides a large amount of information that is reliable and can be analyzed with ease. A limitation with the method is that it cannot infer cause and effects or compare answers (Kallio, Pietilä, Johnson & Kangasniemi, 2016).

Results

Gholizadeh et al. (2017) reported a significant difference between stress scores before and after implementation of the mindfulness intervention for both the control and experimental groups. A comparison of the two groups indicated no significant difference before the project however after the intervention a significant difference was noted. The authors concluded that mindfulness intervention can reduce job stress among nurses who work in intensive care units. The authors recommended that health centers and hospital managers should put mindfulness intervention training on their agenda as a way of enhancing the quality of health care services and patient satisfaction.  Penque (2019) also had positive results. MBSR reduced job burnout and improved specific psychological factors like mindfulness, self-compassion, and serenity. The author recommended the use of mindfulness-based programs among nurses to help them develop skills to manage clinical stress and improve their health. The program was also recommended because it increases overall attention, empathy, and presence with patients and families. Additionally, it increases work satisfaction, reduced incidental overtime and decreases job burnout.

The interviews by Hugh-Jones et al. (2018) were analyzed using a grounded theory which helped in generating a provisional model that explained how mindfulness led to positive changes. The model indicated that multiple, positive benefits were created by discrete, temporal experiences.  Mindfulness-based interventions increase attention, resonance, self-care, detection of stress markers and help in recovering self-agency. Lynch et al. (2018) found out that work pressure results in perceived stress which requires a wellness program to control. The staff indicated that medication increase attention and awareness, regulate emotion, enhance relaxation and sleep quality and generate coping mechanisms. Some participants reported feeling guilt for participating in the MM program while they can serve in other places. Barriers to practicing meditation were shift work, length of practice and individual differences. Facilitators were organizational support and internal support.

Implication on Nursing Practice

Gholizadeh et al. (2017) and Penque (2019) recommend the need to adopt mindfulness programs to help nurses’ redirect negative thinking and reframe difficult situations. The programs help nurses to handle stress, increase focus, awareness, and knowledge. Lynch et al (2018) recommend support to ensure that mediation programmers are embedded into busy hospital environments. The support can be offered as follow-up workshops and retreats and casual staff-organized group meditation sessions. Hugh-Jones et al. (2018) indicate that understanding how mindfulness programs work can increase engagement and trust as well as the ability to apply mindfulness in work life.

Ethical Considerations

Two ethical considerations needed when executing a project are voluntary participation of respondents using informed consent and ethical approval to safeguard the dignity, well-being, safety, and rights of all participants. Gholizadeh et al. (2017) do not outline whether they received approval or used informed consent, however, Penque (2019) states that she obtained approval from Institutional Review Board approval and participants had to willingly complete an informed-consent process. Hugh-Jones et al. (2018) also pointed out that ethical approval was received from the university research ethics committee while Lynch et al. (2018) advised participants to withdraw from the study at any time indicating voluntary participation.

Outcomes Comparison

The proposed study aims to determine whether mindfulness-based practice reduces nurse burnout among ICU nurses. The project primary outcome is reduced nurse burnout. The secondary outcomes assessed will be mindfulness, compassion-fatigue, and turnover rates and reduced stress. Gholizadeh et al. (2017) primary outcome was the average stress score measured using expanded nursing stress scale and job stress assessed using a questionnaire.  For Penque (2019) the study outcomes assessed were the impact of the MBSR program on mindfulness, self-compassion, empathy, and serenity. The instruments used are the Maslach Burnout Inventory, Index of Work Satisfaction, Interpersonal Reactivity Index, Brief Serenity Scale, Self-Compassion Scale, and the Brief Freiburg Mindfulness Inventory. Although not specified, thematic analysis by Lynch et al. (2008) revealed outcomes like work pressure and perceived stress, benefits of meditation, conflicting attitude, barriers to meditation and facilitators to meditation. Hugh-Jones et al. (2018) also generated themes like developing attention and awareness. All the outcomes are aimed at assessing the positive impact of mindfulness practice.

Conclusion

Critical appraisal of research articles helps in establishing their value, relevance, and integrity. As indicated above, four articles were appraised to illuminate the impact of the mindfulness-based practice on nurse burnout. The four articles indicate that working in ICU, critical care and emergency department increases stress among healthcare professionals. The stress results in burnout and increased turnover rates. The stress can be minimized using mindfulness practice, mindfulness-based stress reduction, mindfulness interventions, and mantra meditation. All these approaches result in better outcomes as indicated by positive results registered by the authors. The two quantitative studies appraised have adopted a randomized control trial design and quasi-experimental design while the qualitative articles used semi-structured interviews.  The articles show that mindfulness-based results in decreased stress, burn out and improved psychological factors like mindfulness, self-compassion, and serenity. The articles reveal a need to implement mindfulness interventions in nursing practice as a way of helping nurses redirect negative thinking and reframe difficult situations. The articles also have adopted the required ethical consideration with most of them getting approval and providing informed consent to participants. The outcomes of the analyzed articles also closely match the outcomes of the proposed project since all assess the positive impacts of the mindfulness-based practice.

References

Gholizadeh, M., Khademohosseini, S. M., Nouri, J. M., & Ahmaditahoor, M. (2017). The Effect of Mindfulness Intervention on Job Stress in Nurses of Intensive Care Units. Journal of Critical Care Nursing, 10(3).

Hugh-Jones, S., Rose, S., Koutsopoulou, G. Z., & Simms-Ellis, R. (2018). How is stress reduced by a workplace mindfulness intervention? a qualitative study conceptualizing experiences of change. Mindfulness, 9(2), 474-487.

Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi‐structured interview guide. Journal of advanced nursing, 72(12), 2954-2965.

LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-E-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.

Lynch, J., Prihodova, L., Dunne, P. J., O’Leary, C., Breen, R., Carroll, Á., … & White, B. (2018). Mantra meditation program for emergency department staff: a qualitative study. BMJ Open, 8(9).

Morrison, K. (2017). Dissecting the literature: the importance of critical appraisal. Royal college of surgeons.

Penque, S. (2019). Mindfulness to promote nurses’ well-being. Nursing Management, 50(5), 38.